Archive for Pennsylvania Medicaid laws and regulations
The following is a summary of the major COVID-19-related developments in Pennsylvania today. Telemedicine The Office of Medical Assistance Programs has issued guidance for providers on the use of telemedicine services for Medicaid patients – those covered both by managed care plans and on a fee-for-service basis. Learn more from the newly posted telemedicine guidelines and a separate memo to the HealthChoices managed care plans from the state. In addition, CMS issued a waiver for certain restrictions on the provision of telemedicine services under the Medicare program. The details of the wavier are described in a Fact Sheet and FAQ. New Guidance From the State Today the state published a number of COVID-19-related resources: ICD-10-CM Official Coding Guidelines Related to … Read More
New human services efforts to support vulnerable populations are a major part of Governor Tom Wolf’s proposed $36.06 billion FY 2021 budget for Pennsylvania. The proposed budget, presented to the state legislature earlier this week, includes the following new initiatives: creating pathways to success in the workforce for low-income Pennsylvanians increasing the minimum wage to $15 increasing Department of Human Services staffing to support licensing and oversight supporting adults in long-term-care facilities legal services for vulnerable populations direct care worker comprehensive training commitment to performance-based metrics, accountability, and transparency in services and licensing supporting vulnerable populations through home- and community-based services and reducing waiting lists prevention services to support at-risk families improving food security while supporting agriculture Go here to … Read More
Pennsylvania’s new Medicaid preferred drug list is presented in an October 10, 2019 state Medical Assistance Bulletin. The Department of Human Services bulletin outlines the purpose of the new PDL, provides background information, and describes how the PDL was developed and will work. In addition, it lists the past Medical Assistance Bulletins rendered obsolete by the new bulletin and describes the prior authorization procedures that will be employed when the new program takes effect on January 1, 2020. Finally, the bulletin includes a comprehensive list of the prescription drugs on the new PDL. See the October 10 PDL Medical Assistance Bulletin here.
The Pennsylvania Health Law Project has published its September 2019 newsletter. Included in this month’s edition are articles about: changes in federal “public charge” regulations and their implications for immigrants who are currently enrolled in Medicaid or considering applying to participate in the program; the right of participants in programs sponsored by the state’s Department of Drug and Alcohol Programs to continue receiving services while they appeal denials of services or reductions of services; changes in the application process for state-paid home and community-based services; and the continued implementation of the Community HealthChoices program of managed long-term services and supports for low-income seniors. Go here for articles about these and other subjects.
Undeterred by past defeats, members of PA’s state senate are again attempting to advance Medicaid work requirement legislation. This time, the proposal to impose a Medicaid work requirement will add new flexibility to such a requirement, offering exemptions for individuals deemed “medically frail” and enabling individuals who do volunteer work, attend college, or who are actively looking for work to continue qualifying for Medicaid benefits. The proposal will be considered by the Senate Health and Human Services Committee. The legislature has passed two Medicaid work requirement bills in the past but Governor Tom Wolf has vetoed them. Learn more about this latest effort to establish a Medicaid work requirement in Pennsylvania in the PA Post article “Wolf, Republicans resume tug-of-war … Read More
The Pennsylvania Health Law Project has published the November 2018 edition of its newsletter. Included in this edition are articles about: Community HealthChoices, the state’s program of managed long-term services and supports for eligible Medicaid/Medicare beneficiaries; the return of General Assistance cash grants to Pennsylvania; Governor Wolf’s veto of legislation that would impose a work requirement on many Pennsylvania Medicaid recipients; an increase in the income limits for eligibility for PACENET, the state’s prescription drug assistance program; and a federal proposal to change “public charge” regulations. Find these stories and others here, in the latest edition of the Pennsylvania Health Law Project’s newsletter
The Pennsylvania Health Law Project has published its May 2018 newsletter. Included in this month’s edition are stories about: The continued implementation of Community HealthChoices, the state’s new program of managed long-term services and supports for dually eligible Medicaid and Medicare beneficiaries. The introduction of a new tool for determining whether Medicaid beneficiaries shall be deemed eligible for Medicaid long-term-care services. State legislation that, if adopted, would establish presumptive eligibility for older adults applying for in-home care. A new framework for participants in state Medicaid managed care programs to appeal denials of services. New processes to streamline the determination of eligibility for Medicaid of individuals recently released from prison. Pending legislation that would permit selected mental health facilities to deem … Read More
The Pennsylvania Health Law Project has just published the March 2018 edition of its monthly newsletter. Included in this edition are articles about: new procedures that will make it easier for Medicaid recipients to be treated for opioid abuse the continued implementation of the Community HealthChoices program of managed long-term services and supports for nursing home-eligible seniors, including its introduction in southeastern Pennsylvania beginning next year the work of special needs units in the HealthChoices managed care plans the confirmation of Teresa Miller as Secretary of the Pennsylvania Department of Human Services Find these stories and others here, in the latest edition of the Pennsylvania Health Law Project’s newsletter.
The Pennsylvania Health Law Project has just published the latest edition of its Health Law News newsletter. Included in this edition are articles about the elimination of Medicaid restrictions on prescription drugs for hepatitis C, the launch of the Community HealthChoices program of managed long-term services and supports in the southwestern part of the state, and more. Find these stories and others here, in the latest edition of Health Law News.
The Pennsylvania Department of Human Services has issued a new Medical Assistance Bulletin titled “Hospital Responsibilities Related to the Uncompensated Care Program and Charity Care Plans.” According to the document, The purpose of this Medical Assistance (MA) Bulletin is to remind hospitals of the requirements for the Hospital Uncompensated Care Program (Program) and reinforce the responsibility of hospitals to actively engage patients when determining eligibility for the Program. See the entire Bulletin here.